I admit to being quite surprised—and delighted—by the news that the Supreme Court upheld nearly all parts of the Affordable Care Act (“ACA”) or what the right often calls “Obamacare.” When Chief Justice Roberts joined the four justices already expected to find the law constitutional, he defied my expectations.
Perhaps you can forgive my pessimistic outlook due to my personal involvement with the 90 year battle for the federal government to make sure that all Americans have equitable access to quality healthcare.
Twenty-five years ago in northeastern Minnesota, I led a pilot project funded by the state and private foundations. Our mission was to create a basic health plan that would be affordable for small businesses and their employees. Business owners and workers alike were enthusiastic and ready to join.
But we failed because the major health insurers in our area put pressure on hospitals and physician groups to not join the preferred provider organization that was needed to be the healthcare network to make it all work. And this after they had officially said they supported our pilot and wanted to help it work.
Our painful failure had a silver lining and helped persuade the Minnesota Legislature to create a plan called MNCare that provided limited primary coverage to individuals funded by a tax on all healthcare services. MNCare still exists but has been a perennial target of funding cut/tax cut lobbysists and legislators ever since.
In the process of failing, I learned a lot about both the health insurance industry and about citizen expectations of health care. It convinced me that health insurers wouldn’t cooperate to solve the problem of uninsured Americans. And it showed me the intellectual dishonesty of economists and politicians who persist in comparing the purchase of health care to the purchase of a car or other large ticket item.
The fact is that healthcare is a product like virtually none other in a capitalist economy. It isn’t governed by rational consumer decision-making. And it never will be.
That’s why we needed Obamacare. That’s why President Obama and the Democratic members of Congress who supported the ACA deserve huge thanks from all Americans. Finally we’re on the path to significant change in expanding health care access to all our citizens.
It’s about time.